Provider Demographics
NPI:1316082951
Name:SPEED, TERRI LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:LYNN
Last Name:SPEED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9098 LAGUNA MAIN STREET
Mailing Address - Street 2:STE 4
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-691-1600
Mailing Address - Fax:916-691-1602
Practice Address - Street 1:9098 LAGUNA MAIN STREET
Practice Address - Street 2:STE 4
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-691-1600
Practice Address - Fax:916-691-1602
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist